Provider Demographics
NPI:1255640975
Name:DAVIS, EMILY MAUREEN (RPH)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MAUREEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-8407
Mailing Address - Country:US
Mailing Address - Phone:803-222-7431
Mailing Address - Fax:
Practice Address - Street 1:5401 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COWPENS
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-463-4986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12828183500000X
NC10426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC12828OtherSTATE PHARMACY LICENSE